Let’s begin with one of the biggest myths about arthritis: There are two kinds—osteoarthritis and rheumatoid arthritis. Wrong!
“Few medical terms are as unfortunate as ‘arthritis.’ The textbook is 2,000 pages long,” says Dr. Francisco Garriga, a rheumatologist on staff at SSM St. Mary’s Health Center. He also was recognized this month as the 2013 Medical Honoree for the Arthritis Foundation’s Arthritis Walk in St. Louis. “The textbook does not go on for 2,000 pages describing only two illnesses—I should be that lucky,” he says.
In fact, “there are actually more than 100 types of arthritis, including osteoarthritis, rheumatoid arthritis, fibromyalgia, gout and osteoporosis,” says Karen Shoulders, director of programs for the Arthritis Foundation. “Osteoarthritis is the most prevalent, affecting 27 million Americans; Rheumatoid affects 5 million; and more than 300,000 children in the U.S. are affected by juvenile arthritis.”
In all its many forms, arthritis may be painfully obvious or go undiagnosed for years. “Osteoarthritis (OA) and rheumatoid (RA) represent two different types of arthritis,” explains Dr. Akgun Ince, a rheumatologist with Mercy Hospital St Louis. “Inflammatory arthritis (RA) is a systemic disease, and tends to cause more fatigue and prolonged morning stiffness. On the other hand, OA tends to cause joint pain and stiffness, which is more typical at the end of the day, and can increase with prolonged immobility. Both types of arthritis can cause joint pain and swelling, but RA patients tend to have softer swelling and increased warmth in their joints rather than bony swelling, which is typical for an OA patient.”
In addition to joint swelling and pain, arthritis can cause fever, rashes and fatigue. Diagnosis requires a detailed patient history, as well as lab and imaging studies, to determine whether inflammation is present. In the case of rheumatoid arthritis, which affects the immune system, early diagnosis is especially important in order to begin treatment that can slow progression of the disease.
“The important thing is starting (patients) on medications that modify their disease,” says Dr. Deborah Parks, a rheumatologist with Washington University Physicians. However, she notes that patients diagnosed very early who have no apparent joint damage may be concerned about the potential side-effects of medications. “And yet, the severity of their disease and how much it affects their ability to function makes a difference in which drug we choose.”
The most commonly used disease-modifying agent for rheumatoid arthritis in the United States is the drug Methotrexate. “However, in the last 10 to 15 years, biological drugs have become available, and they are very effective in the treatment of RA,” Ince says. “Unfortunately for OA, there are no disease-modifying agents and the most common used drugs are NSAIDS (nonsteroidal anti-inflammatory medications, such as Advil), pain medication and physical therapy. A last resort would be joint replacement surgeries.”
Garriga adds that many patients are frustrated by a lack of support and understanding of the life-altering effects of arthritis. “The worst part of it all: When people tell you how great you look,” he says. “Many other diseases leave visible proof that you're under the weather. Not my illnesses. I wish I had a nickel for all the times patients come in fuming because no one seems to understand just how much of a disease burden they carry and cope with.”
Garriga concludes with common-sense advice. “Eat well, exercise, feed your soul, love your supporters and be grateful for their presence in your life. Enjoy the little nuggets of joy that destiny throws your way once in a while. Don't be afraid to ask for help. Write your symptoms down, do your research and become involved. Help others. Live.”